Canadian Doctors Speak Up

Emergency-room doctors say bystanders are morally obligated to perform chest compressions on cardiac arrest victims - whether or not they have been properly trained in cardio-pulmonary resuscitation - and CPR must be considered a “life skill” for all Canadians.

Representatives of the Canadian Association of Emergency Room Physicians (CAEP) told a news conference on Thursday that too many cardiac arrest victims are dying because the person beside them doesn’t know what to do, and is afraid to act.

“It must become a moral obligation and a social expectation that bystanders will perform CPR when they witness a cardiac arrest,” the doctors said in a position statement released to reporters. “The general population must come to understand that cardiac resuscitation is much more likely to be successful when CPR is started promptly, and the victims of cardiac arrest will almost certainly die if lay witnesses do not intervene.”

Every year, more than 20,000 people in Canada suffer a cardiac arrest outside of a hospital. It is the leading cause of death in this country and fewer than one in 10 people who have a heart attack in their home or on the street will return to normal health.

The odds of survival are increased by 300 to 400 per cent if the victims receive CPR immediately. But, even though half of all cardiac arrests that occur outside a hospital are witnessed by someone in the vicinity, bystanders jump in to help just 25 per cent of the time.

Increasing that rate to 50 per cent - as is the now case in a few Canadian communities - could save 2,000 lives annually, says the CAEP.

The doctors say they realize there reasons why bystanders are reticent to intervene. Many people do not know CPR. And, among the 60 per cent of Canadians who have been trained in the procedure at least once, the skills are often rusty. That leads to “hesitation and inaction.”

But the CAEP says “all Canadians should respond and provide chest compressions (with or without mouth-to-mouth ventilation) whether they are trained or not, when an adult, child or infant suddenly collapses.” And 9-1-1 ambulance dispatchers should provide CPR instructions to all those who call to report a cardiac emergency, say the doctors.

The American Heart Association and the Heart and the Stroke Foundation of Canada updated their resuscitation guidelines last year to say that compressing the chest of a cardiac arrest victim at a rate of about 100 times a minute is most critical response to a heart attack. It is something that can be done without training.

But the doctors also argue that every Canadian should learn CPR.

They recommend that life-saving education be a considered a pre-requisite for a high school diploma, tax exemptions should be given to companies who pay for CPR training for their workers, and individuals who take a CPR course should receive a 100-per-cent tax rebate.

In addition, the CAEP says it wants to join with other like-minded organizations to spearhead a national campaign to advance the cause of bystander CPR.

It could start with wallet size cards to be handed out by physicians that explain the importance of the procedure along with a computer link and telephone number so Canadians can learn when and where courses are held, say the doctors. Seniors could be a particular focus of the campaign because they are more likely to witness a cardiac arrest than younger people.

But “there must be widespread recognition,” says the CAEP, “that CPR is a simple but vital life skill everyone should learn and then put into practice in emergency situations.”

Editor's Note: An earlier version used heart attack and cardiac arrest as synonymous terms. The CAEP's statement refers to cardiac arrest victims.

Close call on school field carries lessons

October 11, 2011 | 3:00 p.m. Lessons can be learned from tragic events. In Baltimore County, we are fortunate that recently lessons have emerged, but a tragedy was averted.

Fast action and the fortunate presence of expertise combined on Sept. 27 to save the life of a teenager who went into cardiac arrest on an athletic field at Catonsville High School.

Breanna Sudano, a freshman on the Perry Hall High School junior varsity field hockey team, collapsed at the conclusion of a game at Catonsville High.

Among those present who were able to respond quickly to the emergency were two coaches and three nurses — one of them a cardiac nurse. They worked as a team to provide cardiopulmonary resuscitation.

Almost unquestionably, they saved this young athlete's life. They kept her pulse going until paramedics arrived and gave the girl an electric shock from an automated external defibrillator, which boosted her heartbeat.

One nurse later told a reporter she could not have done it alone. "There is no way one person could have done CPR by themselves. It was a team effort," she said.

The incident highlighted some issues that are worth discussing.

First, while a 2006 state law requires that an AED be available at a school for sporting events, the one at Catonsville was in the school building, some distance from the field.

Second, emergency response vehicles pulled into the wrong entrance at the stadium. The school's address covers a wide area and the caller did not specify the field where the incident was happening.

It's important that emergency responders know the layout of the high schools nearby. With the addition of lights and artificial turf, and fields now in use by recreation department and interscholastic programs, the potential for injury has gone up.

In any such emergency incident, it would seem a review of protocols and response is in order. Likely, it's already under way and will serve to sharpen preparedness.

That's a good thing. After all, next time, a lifesaving team may not be on the sideline.

It's either sloppy reporting or really tragic.

A math teacher at East Central High School died Monday morning after collapsing before classes started, officials said.

Melinda Villegas, 23, a full-time math teacher for all grades at the high school, was with colleagues, who “immediately started assisting her and went to get our school nurse's assistant to administer CPR,” said Stevie Gonzales, an East Central Independent School District spokeswoman.

“EMS continued the CPR in transporting her to Mission Trail Baptist Hospital,” where she was pronounced dead around 8 a.m., Gonzales said.

Read more: http://www.mysanantonio.com/news/local_news/article/East-Central-teacher-23-dies-after-collapsing-2212049.php#ixzz1aQfmU64I

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[note: the obvious concern when reading "...with colleagues, who “immediately started assisting her and went to get our school nurse's assistant to administer CPR." is the implication that nobody called 911 or started CPR before the Nurse's Assistant arrived. This also implies that nobody defibrillated her promptly at the scene.

The Phoenix airport has a ten year average survival from witnessed cardiac arrests with major brain functions intact of 75%, as opposed to a 6% survival rate with no worse than a CPC 2 score when all that is done is call 911 and wait for the ambulance. The answer is call 911, start CPR immediately, and defibrillate promptly.]

About half...

...of the people interviewed in 2007 know or were able to guess the difference between a sudden cardiac arrest and a heart attack.

When the score is that close to 50/50, usually folks are guessing.

It's important because immediate 911 and CPR. plus prompt defibrillation are essential to cardiac arrest survival with major brain function intact, and 911 is essential for a heart attack. The defibrillator won't hurt the heart attack victim, but CPR would be inappropriate and dangerous.

Fortunately, they are easy to tell apart, once you've been told the difference: The sudden cardiac arrest victim - the one that needs 911 + CPR + AED - is non-responsive and not breathing, either normally or at all.

If you are not trained, check the video at www.slicc.org/ClassVideo and then get the people whom you frequently are near trained, too.

It's a 35 minute video. There HAS to be a 35 minute slot available in your schedule sometime. You have about a ten percent of seeing a family member, friend, or acquaintance die from a sudden cardiac arrest in your lifetime. It would be better for all if you were to watch the video before that happens, rather than after.

Do the Fire and Police Vehicles...

all carry AED's where you live and work?

Shock, sorrow after teen cheerleader's death in Los Angeles

LOS ANGELES — When students returned for school Monday morning at Washington Prep, they were to be greeted by crisis counselors and missing one of their beloved classmates, a cheerleader who died after collapsing during a football game.

Angela Gettis, a 16-year-old sophomore at the school, was rallying the crowd Friday night in the fourth quarter of a tie game at Fremont High School when she suffered an apparent cardiac arrest, Los Angeles Unified School District spokesman Tom Waldman said.

The game stopped as coaches and trainers ran to help. Bystanders performed CPR while waiting for paramedics to arrive. Gettis died about three hours later at a hospital, becoming the second teenage girl from Los Angeles district schools to die over the weekend after a dramatic campus incident.

School officials planned to discuss Gettis at a Monday morning news conference.

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[Question: was there an AED there, and was it used? rht]

SCA Hits Perry Hall High JV Field Hockey Team

Trauma Strikes the Field Hockey Teams Wednesday, September 28, 2011 By Ethan Muller From Perry Hall High's online newspaper

In life, situations can go from happy and exciting to gloomy and traumatic in a matter of seconds. Last night, September 27, 2011 the JV and Varsity Field Hockey teams experienced one of these moments. Shortly after scoring the winning goal, her second of the afternoon, a freshman on the JV team collapsed on the field at Catonsville High School. The coaches and athletic director rushed to provide medical assistance. The staff administered CPR immediately, which saved the young athlete's life.

While CPR was being administered, another person present at the game called 911 for an ambulance. Upon the arrival of paramedics, she was breathing but remained unconscious. The Varsity game, which was scheduled to directly follow the JV match, was postponed.

After being taken to St. Agnes and confirmed stable, she was moved to the pediatric unit at University of Maryland. The doctors have yet to find a cause of her collapse and tests are still being done. Perry Hall wishes nothing less than a speedy recovery for the student and our thoughts go out to her family and teammates.

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A few points about this story that are interesting...

First, with no mention of AED use by the staff, we either have to assume that it happened but was not reported, or we have to assume that the victim enjoyed a return of spontaneous circulation ("ROSC") on chest compressions alone. I've only seen that happen in one of the forty-nine cardiac arrest events in which i've been involved.

Second, with ROSC and being in a coma (CPC score of 4), this person was an ideal candidate for therapeutic hypothermia ("TH"). We can't tell from the article whether or not TH was applied.

Third, the CPC score of 4 makes me wonder how long the time between the arrest and the initiation of CPR was. If the time was 5 minutes - and you'd be amazed at how fast five minutes can add up - I can understand the CPC 4 score. If the CPR were, indeed, more immediate, there might well be something else going on.